Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | G33242 | CA |
N | 207W00000X | Ophthalmologist | M-6100 | ID |
N | 207W00000X | Ophthalmologist | MD00026268 | WA |
Y | 207W00000X | Ophthalmologist | MD09829 | OR |
NPI | 1023019502 |
---|---|
Provider Name | Dr. Oli I Traustason |
First Address | Redmond, OR 97756-7197 |
Second Address | Redmond, OR 97756-7197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001193 | (05) | OR |
053857009 | REGENCE BCBS (01) | OR |
10283 | CLEAR CHOICE (01) | OR |
180029258 | RAILROAD MEDICARE (01) | OR |
200225 | COIHS (01) | OR |
A009 | TRIWEST CHAMPUS (01) | OR |
R018WCRBJA | (02) | OR |